Registration form: Screen Saver Activate 1.2.5

Name:___________________________________________
Organization:__________________________________________
Address:___________________________________________
___________________________________________
City:___________________________________________
State or Province:______________________________________
Postal code:__________________________________________
Country:___________________________________________
Phone:___________________Fax:_____________________
Email:___________________________________________

Number of copies of Screen Saver Activate to register ($10.00 each):________

____Check here if you wish to receive a copy of Screen Saver Activate on floppy disk.
The price per copy will be increased to $15.00 to cover media and shipping.
Select desired disk format....   3.5"____ or  5.25"____

Call for site / organization license info if registering 10 or more copies.

Payment methods

___ Check here if paying by check or money order.
Payment should be in US funds for $10.00 for each copy of Screen Saver Activate which you wish 
to register. ($10.00 for 1 copy,  $20.00 for 2 copies, $ 30.00 for 3 copies, etc.)
Make the check or money order payable to: Digital Control Systems.

Compuserve registration SWREG ID:8459

We will also accept American Express, MasterCard or  VISA.
___ Check here to charge to your American Express account.
___ Check here to charge to your MasterCard account.
___ Check here to charge to your VISA account.

Name (as it appears on card):_______________________________________
Card Number:_______________________________ Exp date:_____________
Signature:______________________________________________________

If paying by credit card:
You may fax this form to (615) 889-9595.
You may send this form by email : 72660.1040@compuserve.com.
You may also call us at: (615) 889-6357.
Or you may use our Postal mailing address (required for check or money order):

Digital Control Systems
P.O. Box 505
Hermitage, TN. 37076
